Restless legs syndrome (RLS) occurs commonly during pregnancy and can sometimes casues significant sleep disturbance. A new study suggests that RLS may also increase the risk of perinatal depression.

In this study, 1,428 pregnant women were recruited at 16-17 weeks of gestation.  They were followed using web-based questionnaires at weeks 17 and 32, and at 6 weeks after delivery. Data were also collected from prenatal and birth records. Two different sets of criteria were used to examine the prevalence of RLS: the International Restless Legs Syndrome Society Group standard criteria and the CH-RLSQ11 questionnaire. The latter questionnaire attempts to exclude conditions which mimic RLS.

When the researchers used the standard diagnostic criteria for RLS and a frequency of symptoms greater than 2-3 days per week, the prevalence of RLS in this cohort was 12.3%. When the CH-RLSQ11 questionnaire was used with the same threshold for frequency of symptoms, the prevalence dropped to 6.5%.

Women who reported moderate to severe RLS symptoms were more likely to report depressive symptoms during pregnancy and the postpartum period.  The adjusted odds ratios of depressive symptoms were 4.74 (2.30 – 9.76) at 17 weeks of gestation, 3.67 (1.85 – 7.28) at 32 weeks of gestation, and 2.58 (1.28 – 5.21) at 6 weeks postpartum.  This finding was observed only in women who reported a history of RLS prior to pregnancy; women who experienced first time onset of RLS during pregnancy were not at increased risk for depressive symptoms.

To our knowledge, this is the first report linking RLS to an increased risk of perinatal depression.  While future studies are required to better understand the link between RLS and depression, this is an interesting finding which underscores the importance of sleep quality in pregnant and postpartum women.  There are an increasing number of studies which indicate that sleep disturbance is a risk factor for perinatal depression.  Other studies have demonstrated that interventions designed to improve sleep may reduce the risk of postpartum depression, highlighting the importance of sleep monitoring and appropriate interventions in this vulnerable population.

Ruta Nonacs, MD PhD

Wesström J, Skalkidou A, Manconi M, Fulda S, Sundström-Poromaa I. Pre-pregnancy restless legs syndrome (Willis-Ekbom Disease) is associated with perinatal depression. J Clin Sleep Med 2014;10(5): 527-533.